Long-acting injectables cut manic relapse in bipolar disorder

The edition in brief

Today's psychiatry desk leads on outcomes after NMDA receptor encephalitis: in 70 post-acute patients scanned a median 22 months from onset, 67 per cent still had residual symptoms — memory dysfunction in 61 per cent and psychiatric symptoms in 36 per cent — and the psychiatric phenotype had shifted from psychosis-dominant at peak illness to affective-dominant later, alongside reduced hippocampal and fronto-cingulo-temporal morphological complexity. A prospective multisite study of 269 patients with major depression found that a rise in dentate gyrus volume across treatment was driven almost entirely by the 41 who had electroconvulsive therapy, and tracked only the core depressive dimension, not anxiety, somatic, insomnia or cognitive measures — evidence against dentate gyrus plasticity as a shared antidepressant mechanism. A cross-sectional study of 200 people found angiotensin-converting enzyme protein lower in both cerebrospinal fluid and serum in early-stage psychosis (Cohen d −1.16 and −0.92) and lower still in treatment-resistant cases (d −0.50), with genetic burden tracking protein level but not enzymatic activity; this is biomarker research, not a test to order. The practice-changer is a self-controlled case series of 2086 people with bipolar disorder who received both long-acting injectable and oral antipsychotics: during depot periods, psychiatric hospitalisation fell (adjusted IRR 0.67, 95% CI 0.61 to 0.74), manic admissions halved (0.51, 0.44 to 0.59) and mixed-episode admissions fell further (0.31, 0.14 to 0.66), with no signal for depressive admissions and a near-threefold excess of extrapyramidal symptoms confined to the first 90 days.